ABSTRACT
BACKGROUND: The ability of breast-feeding infants to utilize lactose, the major carbohydrate in breast-milk, is dependent on the presence of the enzyme lactase (E.C.3.2.1.108). Lactase is located in the brush border of the small intestine and because of its exposed position it is extremely vulnerable to pathogenic damage. Breast-fed Gambian infants have poor growth associated with intestinal damage beyond 3-4 months. The aim of this study was to assess the ability of Gambian infants aged 2-15 months (N = 113) to digest lactose and to see how this varied with age, intestinal permeability, and growth performance. METHODS: Lactose maldigestion was estimated by monthly measurements of urinary lactose and lactulose following an oral dose of the latter. RESULTS: Both urinary lactose excretion and lactulose maldigestion increased with age (p < 0.0001 ANOVA). Up to 6 months the mean urinary lactose: lactulose excretion ratio was within the quoted normal range (< 0.4). Beyond this age, mean values were hypolactasic. Lactose maldigestion was related to poor growth in both weight and length (r = -0.04, p < 0.0001, after age correction). Although a major part of this relationship was a reflection of the previously reported correlation between intestinal permeability and growth, more than 30% of the association was in addition to the permeability effect. Possible explanations are discussed. CONCLUSIONS: Moderate-to-severe hypolactasia does occur in breast-fed Gambian infants and is related to poorer-than-expected growth. However, this does not mean that breast milk intake should be reduced as the nutritional and immunological benefits of breast milk continue to outweigh any disadvantages.
Subject(s)
Breast Feeding , Lactose Intolerance/diagnosis , Aging , Body Height , Body Weight , Gambia , Humans , Infant , Intestinal Mucosa/metabolism , Lactase , Lactose/urine , Lactose Intolerance/metabolism , Lactulose/metabolism , Lactulose/urine , Mannitol/metabolism , Permeability , beta-Galactosidase/metabolismABSTRACT
There is controversy over whether children in developing countries can catch up on their growth rates after bouts of diarrhoea. A factor influencing catch-up growth is the extent and duration of mucosal injury. To explore the relation between intestinal disease and growth performance, a non-invasive test of intestinal integrity, the lactulose:mannitol permeability test, was done regularly on children aged 2-15 months, whose growth was monitored over a mean of 7.5 months. The study revealed persistent abnormalities in the small bowel mucosa of 2-15 month old Gambian infants and a negative correlation between these abnormalities and growth. Up to 43% of observed growth faltering can be explained on the basis of these long-term intestinal lesions.
Subject(s)
Diarrhea, Infantile/complications , Growth Disorders/etiology , Intestinal Absorption/physiology , Intestinal Mucosa/physiopathology , Body Height , Body Weight , Gambia , Growth Disorders/physiopathology , Humans , Infant , Lactulose , Mannitol , Prospective Studies , Rural HealthABSTRACT
Chronic diarrhoea and malnutrition in Gambian children is associated with persisting damage to the mucosa of the small intestine. Intestinal permeability tests suggest that mucosal status gradually deteriorates with age throughout the first year of life in tandem with increasingly severe growth faltering. The ability of the dual sugar permeability test to assess intestinal mucosal status frequently in a non-invasive way makes the technique a valuable tool for future studies into the aetiology of this syndrome.
Subject(s)
Child Nutrition Disorders/physiopathology , Diarrhea/physiopathology , Intestinal Mucosa/physiopathology , Age Factors , Child Nutrition Disorders/diet therapy , Child Nutrition Disorders/pathology , Child, Preschool , Chronic Disease , Diarrhea/diet therapy , Diarrhea/pathology , Gambia , Humans , Infant , Infant, Newborn , Intestinal Mucosa/pathology , Lactulose/pharmacokinetics , Mannitol/pharmacokinetics , PermeabilityABSTRACT
We have measured the prevalence of active trachoma in children aged less than 15 years in the Gambian village of Keneba, which has had excellent free medical care and a continuous supply of antibiotics since 1974. The prevalence was 13%, with the peak prevalence (20%) occurring in the 2 to 3-year age group. Of 71 cases diagnosed, only 23 (33%) had complained of ocular symptoms in the previous 3 months, in spite of the fact that 66 (94%) had attended the clinic. Only five had been diagnosed as having trachoma by the duty paediatrician (7%). Compliance with treatment was poor, with only 29 subjects returning for continued treatment (41%), and at follow-up 16 months later 22 of 64 subjects still had active disease (34%). We conclude that the widespread use of antimicrobial agents does not preclude the persistence of endemic disease. Socio-economic improvement or behavioural changes appear necessary for the control of trachoma in endemic areas. In the meantime there is a need for greater awareness of the disease both among clinicians in endemic areas and among the communities afflicted.
